Sigmoid ulcer: causes, symptoms, treatment

Sigmoid ulcer is an inflammatory lesion of the mucous membrane of the sigmoid colon, which are formed quite deep defects of the mucous membrane.

The disease often lasts a long time, with alternating periods of exacerbation and remission (disappearance of clinical symptoms). Complications of ulcer of the sigmoid can be critical for the health and life of the patient.

This pathology is the most severe form of sigmoid – inflammation of the mucous membrane of the sigmoid colon. In most cases it is influenced by several pathogenic factors.

The causes of ulcerative sigmoid

The immediate cause of the development of ulcerative sigmoid – pathogenic effects on the mucous membrane of the sigmoid colon pathogens. The disease can be caused by any infectious agent. Most often the occurrence of ulcerative sigmoid provokes the classic “four” bacteria that are the cause of almost all inflammatory processes occurring in the large intestine. It’s such pathogens as:

Less provoking moment can be:

Relatively rare in the development of ulcerative sigmoid involved specific infection (the causative agents that trigger the development of a certain kind of an infectious disease). But about their possible involvement in the development of ulcerative sigmoid should also be remembered. This includes such pathogens as:

and so on.

Highlighted a number of factors that directly to vospalitelno-ulcerative lesions of the sigmoid colon do not cause, but can contribute to ulcerative sigmoid. This:

• disorders of local blood circulation the sigmoid colon;
• mechanical trauma of the mucous membrane;
• the use of certain drugs;
• ionizing radiation in high doses;
• Smoking.

The local blood circulation disorders of the sigmoid colon, which can lead to the development of the described diseases, most often develops on the background:

• systemic diseases of the vascular system;
• diseases of the blood.

Most often the development of ulcerative sigmoid can contribute to such diseases of the vascular system, such as:

• systemic atherosclerosis – the formation of vascular plaques on the inner surface of the vessel;
• thrombosis of mesenteric vessels – arteries and veins, which run in the mesentery of the intestine (connective tissue film, with which the intestine is attached to the inside of the abdominal wall);
• arteriovenous malformation – an abnormal connection between the vessels of the arterial and venous type;
• trombangiit obliterans – inflammation of the walls of arteries and veins with the development of autoimmune aggression;
• periarteritis nodosa – inflammation of the arterial wall with subsequent formation of small aneurysms (bulging of the vascular wall in the form of a bag).

Diseases of the blood, contribute to the deterioration of the intestinal circulation and the development of ulcerative sigmoid, is often:

• DIC (disseminated intravascular collapse) – education in the vessels of multiple blood clots due to the massive release of tissue substances involved in the clotting
• neoplastic diseases of the blood;
• various types of thrombocytopenia – reduced platelet count;
• hemoglobinopathies – violation of the structure of hemoglobin, which impairs the function of red blood cells

and some others.

Mechanical trauma to the wall of the sigmoid colon that trigger the development of peptic ulcer of the sigmoid, may occur as a result of the following reasons:

• long constipation – disorders of the passage of fecal contents to the large intestine it is condensed, formed a solid fecal particles that systematically hurt the mucous membrane of the sigmoid colon;
• fecal stones – solid large particles, which are formed due to compaction of feces as a result of various diseases of the large intestine or age-related changes;
• passing through the colon of solid food particles that are left undigested (the fish bones, fragments of animal bones, fruit stones);
• trauma of the mucosa of the sigmoid colon solid foreign objects that were accidentally or intentionally swallowed (badges, pins, studs, knives, forks and so on);
• violation of the integrity of the mucosa during diagnostic procedures – sigmoidoscopy, colonoscopy;
• damage to the mucosa during surgical operations for diseases of the sigmoid colon or abdominal cavity.

When drug therapy is often the development of ulcerative sigmoid provoke:

The development of ulcerative sigmoid because of radiation exposure most often develops on the background radiation therapy, which is practiced in diseases of the pelvic organs or the colon.

Smoking provokes narrowing of the blood vessels, which impairs blood circulation of the intestinal wall. As a result of this pathological influence regenerative (rehabilitation) processes in the tissues of the intestinal wall deteriorate significantly. Sigmoid ulcer complicated by perforation and bleeding are more common in smokers than non-smokers.

The development of the disease

Ulcerative sigmoid is a type of segmental colitis (inflammation of one of the sections of the large intestine). The formation of ulcers of the mucous membrane of the sigmoid colon precedes the development of inflammation in it, and then the formation of erosions, small defects. If the patient ignored the doctor’s visit, which appropriate therapy had not been appointed, and pathogenic factors continue to affect the intestinal mucosa, erosions become deeper and more extensive, transforming into ulcers.

Pathology may be in the form of forms, such as:

• sharp;
• chronic.

The acute form of the disease is characterized by sudden onset and rapid development. Often it develops at:

• infectious lesions of the sigmoid colon;
• constipation;
• ischemia of the wall of the sigmoid colon – the shortage of oxygen through the pathology of blood vessels.

Chronic ulcer of the sigmoid variation develops gradually – often from a few months up to one year, and morphological violations are progressing slowly, periods of exacerbation alternating with periods of remission. For a long time in the intestinal mucosa observed erosive changes, and only with regular exposure to pathogenic factors ulcers.

In some cases, ulcerative sigmoid proceeds together with ulcerative proctitis.

Symptoms of ulcerative sigmoid

Characteristic features of ulcerative sigmoid are:

• pain;
• the intestinal discomfort;
• tenesmus;
• violation of the chair;
• pathological impurities in the stool;
• in the long-term ongoing process, violations of the General condition of the body.

Characteristics of pain:

• localization in the left iliac region (lower abdomen);
• distribution can irradiate in the area of the left flank (lateral portion of the abdomen), rectum, perineum, inner surface of left thigh, sometimes in the lower back;
• character and appearance – similar to periodic contractions;
• intensity – intense, aggravated by the attempt of the patient to raise the left leg.

Often pain reminiscent of the pain syndrome that occurs when acute appendicitis.

The discomfort manifests itself as strange unpleasant sensations in the region of the sigmoid colon.

Tenesmus (false urge to defecate) appear due to the periodic spastic contractions of the muscle fibers of the intestinal wall.

Most often, a violation of stool ulcerative sigmoid manifest as periodic diarrhea, constipation in this disease are rare. Change the cal is quite revealing – he:

• the consistency is a liquid;
• the smell is fetid;
• on features – similar to the color of meat slops.

In feces most often there is blood before the stool comes out, the blood has time to partially mix with it. Also possible to Calais impurities mucus, and the development of complications of purulent – pus. Sometimes blood, mucus or pus can come out in a small amount out of the act of defecation, namely, during an attack of tenesmus.

Violations of the General condition of the body can develop in the long-term current sigmoid. They arise due to the fact that disturbed defecation – that is, suffers a mechanism of excretion of waste products of the body. In particular, experience the following symptoms:

• weakness;
• sleep disorders;
• poor appetite;
• irritability and emotional instability.

Diagnosis of ulcerative sigmoid

Clinical symptoms of ulcer of the sigmoid can be observed in other diseases of the large intestine, therefore, for an accurate diagnosis there is a need for additional methods of examination. Physical, instrumental and laboratory methods in this case are equally valuable for understanding the clinical picture of the disease.

In the result physical examination revealed the following:

• at the General survey – at the initial stages of the patient have not changed, with the progression of the disease can be observed emaciation, and if there is periodic bleeding from ulcers – marked paleness of skin and visible mucous membranes of the patient;
• when inspecting the anal area – can be visualized blood, mucous or purulent discharge from the rectum and also irritation, dermatitis (inflammation) and maceration (skin corrosion) perianal skin under the influence of periodic allocations. If ulcerative sigmoid combined with proctitis, the initial stages of development of these two pathologies there is an increase in the tonus of the anal sphincter, with further progression of the incompetence of the sphincter (dysphonia of its edges);
• palpation (feeling) of the abdomen is marked tenderness in the left iliac region. Sometimes sigmoid colon is very mobile (for example, due to a long mesentery), this pain can occur around the navel, or even in the right iliac region;
• percussion (tapping) of the abdomen – soreness of the abdomen confirmed;
• auscultation of the abdomen (listening with a stethoscope) – may increase the peristaltic noise in the form of periodic rumbling of varying intensity.

To confirm the diagnosis of ulcer of the sigmoid used by such instrumental methods as:

• sigmoidoscopy – technical characteristics of the sigmoidoscopy (a variety of endoscopic equipment) allow to reveal ulcerative changes in those parts of the sigmoid colon, which coexist with rectum;
• colonoscopy – a survey carried out with the help of a colonoscope (a flexible probe with mounted optics), while reveal ulcerative lesions of the mucous membrane of the sigmoid colon;
• barium enema – the colon is injected, a contrast agent, and then make a series of x-ray images, which reveal the deep defects of the mucosa of the sigmoid colon and the change in its topography. Often reveal a decrease of the lumen of the intestine, develops as a result of spastic contractions of its walls. Barium enema is contraindicated in the risk of development of megacolon (enlarged sigmoid colon) and perforation (rupture of the intestinal wall);
• plain radiography – x-ray examination of the sigmoid colon. Apply if the barium enema is contraindicated;
• biopsies during endoscopy do the fence (otsyrevanie) of the mucosa of the sigmoid colon, biopsy is then examined under a microscope.

Most informative of all instrumental methods is colonoscopy, as it is through the optical system to detect ulcerations of the mucosa of the sigmoid colon, to assess their size, depth, presence of bleeding lesions.

The laboratory techniques involved in the diagnosis of ulcer of the sigmoid is:

• General analysis of blood – in the blood reveals increased white blood cell count (leukocytosis), erythrocyte sedimentation rate, which indicates the presence in the body of the inflammatory lesion. General analysis of blood do periodically to track the development (or remission) of inflammatory process in the sigmoid colon;
• coprogram – found in the feces of blood, mucus, pus (in the event of the accession of purulent complications) and slomannye the intestinal epithelium;
• direct microscopic examination of feces – the feces examined under a microscope for the presence of infectious agents that triggered the development of ulcerative sigmoid;
• examination of feces for the presence of helminths – used method for detection of helminthes, which can trigger the development of ulcerative sigmoid;
• bacteriological examination – do stool cultures on nutrient media, colonies that grew draw conclusions about the kind of infectious agent.

Differential diagnosis of

Differential (distinctive) diagnosis of ulcerative colitis should be primarily carried out with such diseases as:

• acute or chronic appendicitis – in particular, the displacement of the sigmoid colon in right iliac fossa or left-sided location of appendiceal Appendix (it can be observed in the so-called transposition of the intestine, where segments take the place on the opposite side of the abdomen);
• Crohn’s disease is the formation of many small tubercles-granulomas throughout the intestine;
• ulcerative colitis – inflammation and ulceration in the mucosa of various departments of the colon.

Complications of ulcerative sigmoid

Ulcerative colitis may occur the following complications:

• perforation of the sigmoid colon with the release of its contents into the pelvic cavity or abdominal cavity. Develops as a result of acute ischemia (lack of oxygen), which leads to necrosis (necrosis) of a portion of the intestinal wall;
• pelvioperitonit – inflammation of the sheets of the peritoneum lining the walls of the pelvis or organs developing in contact with intestinal contents of the sigmoid colon, which was released in the pelvic cavity or abdominal cavity if perforation of the bowel;
• cicatricial deformation of the sigmoid colon – can develop after perforation;
• intestinal obstruction can develop due to narrowing of the sigmoid colon, which was formed after the scarring formed after perforation;
• intestinal bleeding – occurs when erosion of the walls of the larger vessel, if he found himself in the place of the sores;
• malignancy – malignant transformation of rough edges ulcers of the sigmoid colon;
• the intestinal wall abscess – suppuration with the formation of limited ulcers.

Treatment of ulcerative sigmoid

Treatment of ulcerative colitis can be:

• conservative;
• surgical.

Conservative therapy is carried out in the case of uncomplicated ulcerative colitis. During acute exacerbations the patient should be hospitalized in the gastroenterology or proctology Department, in remission treatment is possible on an outpatient basis.

During exacerbation of the appointment of the following:

• bed or polupostelny mode (the patient may for a short time to get out of bed);
• diet;
• drug therapy;
• if ulcerative sigmoid came on the background radiation therapy – cancellation or correction doses.

The principles of diet during exacerbation of ulcerative sigmoid following:

• exclusion from the diet of hot, spicy, sour, salty food, stringy meat, carbonated drinks, confectionery, chocolate, coffee, strong tea;
• drinking alcohol is strictly forbidden (even soft drinks);
• limit intake of coarse vegetable fiber;
• eating 5-6 times a day, small portions;
• the basis of the diet – navaristye soups, soups-creams, fish, chopped vegetables and unsweetened fruit (to prevent increased flatulence), homemade sour curd, dish of minced meat diet (chicken, veal, Turkey). Recommended dishes steamed.

In case of development of severe exacerbation in the first days of fasting with copious drinking, followed by the transition to the diet.

The mainstay of medication therapy on the following assignments:

• antibacterial drugs taking into account the sensitivity of the infectious agent, if necessary – antinematodal agents;
• infusion therapy is prescribed for substantial loss of fluid (in particular, in cases of severe diarrhea). Intravenously administered saline, electrolytes, fresh frozen plasma, glucose;
• probiotics are products containing live microorganisms. Prescribed to maintain normal intestinal flora. Probiotics can be applied in the case of the relief of the acute effects of ulcerative sigmoid;
• vitamins are prescribed to improve the functions of the intestines. They are used in injectable form.

Also, symptomatic treatment is prescribed:

• antispasmodics – with spasmodic pain;
• binding agents – with intense diarrhea.

Surgical treatment in case of complications such as:

• perforation of the wall of the sigmoid colon;
• intestinal bleeding;
• the abscess of the intestinal wall.

Surgical treatment may also be required for the elimination of scar stricture of the sigmoid colon, which can develop as a result of frequent exacerbations and remissions of ulcerative process.

Prevention

The main prevention of ulcerative sigmoid are completely simple measures. The development of this disease can be prevented, if we exclude the impact of all factors that could trigger this disease – an infectious, mechanical, medicinal, radiation.

Of great importance is a balanced diet, thanks to which it supports the normal formation and advancement through the sigmoid colon of fecal matter.

The important role played by preventive examinations, allowing to identify the disease in its earliest stages.

Forecast

The prognosis of ulcerative sigmoid ambiguous, but not critical. The doctor and patient should make great efforts to tissue of the intestinal wall at the site of ulcerations recovered. The process of getting rid of disease is long, it is also possible relapses.

Prognosis worsens with the appearance of complications of the disease – primarily, perforation, bleeding and malignancy.